Dr. Sarah Spencer and Case Supervisor Annette Hubbard see a affected person within the cell clinic outdoors of a shelter in Kenai, Alaska on November 20, 2025.
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Ash Adams for NPR
On the Ninilchik Group Clinic on Alaska’s rural Kenai peninsula this summer season, Dr. Sarah Spencer stood subsequent to a affected person mendacity on an examination desk, and swiped her stomach with alcohol. The affected person was there for a month-to-month buprenorphine shot to deal with her opioid use dysfunction – a shot she thought is likely to be her final for some time since there was a warrant out for her arrest. The Alaska Division of Corrections doesn’t present complete entry to this life saving remedy.
“I am gonna offer you just a little pinch,” Spencer mentioned, sliding the needle right into a fold of pores and skin on the affected person’s stomach for the subcutaneous injection.
Alaska’s not an outlier. Although these lately launched from incarceration are a few of the most weak to dying from drug overdose, dependancy consultants say that many jails and prisons across the nation do not present remedy remedy.
Organizations just like the Ninilchik Group Clinic say they do what they’ll to deal with folks going into or popping out of jail or jail, however can not help these inside. And in response to dependancy drugs specialists, any interruptions in remedy might make it more durable for folks to remain in restoration – and survive their opioid dependancy.
“I actually needed to do good”
Spencer’s affected person on the clinic that day in August was a lady who requested that NPR use solely her first preliminary, H., as a result of she criticized the Alaska Division of Corrections and she or he was afraid of retaliation from workers in jail. She mentioned she was anticipating to be incarcerated for about 6 months.
H. mentioned there are generally contraband medication in jail, and she or he needed to get these pictures so she had one of the best likelihood of staying sober whereas incarcerated.
“I needed to cowl my bases, as a result of I actually, actually needed to do good,” H. mentioned. “I did not wish to go backwards.”
Many research have proven that remedy for opioid use dysfunction makes restoration extra doubtless and reduces the chance of overdose demise.
If folks aren’t in a position to get remedy whereas incarcerated, they could relapse in jail on black market medicationor, if they do not use opioids inside, they may detox and their tolerance will go down. That makes them extra inclined to overdose once they depart.
“There isn’t any inhabitants that is at greater threat than individuals who have been lately incarcerated and a giant a part of that’s as a result of… it solely takes two weeks for folks to lose their tolerance to opioids,” Spencer mentioned.
Dr. Sarah Spencer, Peer Help Specialist Harold Sargeant, and Case Supervisor Annette Hubbard arrange at a location in Nikiski, Alaska on November 20, 2025.
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Analysis backs up the concept that folks despatched to jails and prisons are extremely weak to drug demise. Federal knowledge launched by the Biden administration confirmed as much as 1 in 4 overdose deaths nationally in 2021 concerned folks “lately launched from jail or jail.” And one Nationwide Institute of Well being research discovered that within the weeks after being launched from jail, folks had been as much as 40 instances extra prone to die from overdoses in contrast with the final inhabitants.
H. mentioned the remedy for her opioid use dysfunction was interrupted when she was incarcerated earlier in 2025. She mentioned the Alaska Division of Corrections denied her remedy and she or he began utilizing illicit opioids once more when she obtained out.
“It occurs tremendous quick,” H. mentioned. “I did not have a telephone or something, however you run into folks. You see folks. It simply – there’s 1,000 alternative ways.”
Limitations on remedy
Interviews with healthcare suppliers like Dr. Spencer and previously incarcerated folks like H. point out that many who need remedy whereas incarcerated do not get it.
Alaska’s Division of Corrections, or DOC, declined repeated requests for an interview for this story, however they responded to questions over e mail.
They confirmed that they solely give 30 days of remedy remedy to individuals who had been already getting it earlier than incarceration. Nobody will get remedy for greater than a month, until they’re pregnant. When individuals are launched, DOC mentioned they offer some an inventory of suppliers they’ll go to for remedy.
However Spencer mentioned finest apply is to make it a lot simpler for any inmate to start out and keep on remedy and to offer them with a transition plan – like DOC organising an appointment for them with a healthcare supplier in the neighborhood – to assist them keep protected after launch.
“If a affected person is not continued on their remedy or is not provided remedy, you are actually lacking that chance to stabilize this life threatening illness whereas they’re in DOC custody,” she mentioned.
Dr. Sarah Spencer and Case Supervisor Annette Hubbard talk about numerous circumstances between sufferers. When not seeing sufferers within the cell clinic, each spend their time on the telephone and pc – following up with sufferers, connecting them with assets, and fielding questions.
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DOC mentioned their intention is to develop entry to remedy for opioid use dysfunction, and so they hope to pilot a extra complete program by February of 2026.
Spencer mentioned within the absence of complete remedy, her workforce tries their finest to offer look after folks earlier than and after incarceration, a minimum of on the Kenai peninsula.
Her colleague Annette Hubbard is a case supervisor who routinely checks the courtroom docket for energetic warrants – and helps those that she is aware of have opioid use dysfunction get remedy earlier than they go in.
“I try this voluntarily, as a result of I do know that the folks that I work with and for are at all times in danger,” Hubbard mentioned.
A contrasting method in Rhode Island
Spencer mentioned she needs Alaska’s system had been extra like Rhode Island’s. In 2016, the state began providing remedy for substance use problems to anybody eligible in DOC care. Inside a 12 months, there had been a 61% discount in overdose demise charges amongst folks lately incarcerated, and a 12% discount in overdose deaths statewide.
Dr. Jennifer Clarke developed this system as medical director on the Rhode Island Division of Corrections.
Earlier than she might freely dispense remedy for substance use problems, she mentioned, “it was like practising drugs with one hand tied behind my again.”
In response to Clarke, the outcomes of the brand new program had been palpable: when folks weren’t going via withdrawal and having cravings, they may focus higher on restoration.
“I heard a number of instances, folks would inform me, ‘This was the primary time I might actually take part within the remedy lessons, within the behavioral remedy,'” Clarke mentioned.
However she mentioned it wasn’t at all times simple. This system required two million {dollars} in funding to start out, the backing of the then-governor, and it needed to overcome many logistical hurdles. And he or she mentioned, there was stigma.
“I used to be known as regularly a drug pusher,” she mentioned. “So with the medical workers, I might simply discuss knowledge. I am like, ‘We’re scientists… We’ll comply with the science.'”
Throughout the nation, inconsistent entry to care
Different states have been sluggish to develop comparable life-saving remedy applications. In a current research printed in JAMA Community Openconsultant of over 3,000 U.S. jails, fewer than half provided some entry to remedy for opioid use dysfunction.
Redonna Chandlera psychologist previously on the Nationwide Institute on Drug Abuse, mentioned remedy may be laborious to entry for anybody with opioid use dysfunction, and infrequently jails and prisons do not have suppliers with the experience crucial to present the medicines.
“I feel it is nonetheless a patchwork of applications,” Chandler mentioned.
And since medicines like buprenorphine are opioids themselves and assist alleviate signs of withdrawal, there are black markets for them inside jails and prisons.
Case Supervisor Annette Hubbard holds a field of Naloxene injections that she says the clinic receives from the Treatment Alliance.
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“You may hear a whole lot of considerations about ‘diversion’ and about drugs being diverted, however there are methods to take care of and get round that, both via different formulations or via the methods in which you’d administer the remedy,” Chandler mentioned. That would imply shifting from drugs to injectable formulationsthat are a lot more durable to divert.
Within the meantime, some sufferers like H. in Ninilchik could solely be capable to get remedy outdoors incarceration.
“It could simply be so large to have the ability to get it in jail too, after which achieve that power to have the ability to assist your self once you did hit the streets once more,” H. mentioned.
It is unclear when she’s going to begin her new jail sentence, however she mentioned she hoped when she obtained out, she’d go proper again to remedy. If she does, it could save her life.
